HEALTH TRAIN EXPRESS
Follow or subscribe to Health Train Express as well as Digital Health Space for all the updates for health policy, reform, public health issues. Health Train Express is published several times a week.Subscribe and receive an email alert each time it is published. Health Train Express has been published since 2006.

Wednesday, August 31, 2011

The first hangout was shared by only a few of the best ‘hangers’. It was on short notice, however the time of the ‘H’ will better be placed in the evening after hours…Not many working stiffs (docs), not cadavers can take time to ‘hang’ right after lunch. Steve Eisenberg MD (oncology superior) from Poway Ca and I were ‘hanging’ when his nurse interrupted him for a phone call. He never quite made it back.

Be forewarned…hanging may interrupt and alter your office productivity. Also when leaving the room, mute your video and audio. All the health care techs,, nurses and wannabees will come up to the screen to see who you are.

The next hangout will be in the evening, TBA.

So, if you are a physician and want to ‘poo-poo’ social media, you do so at your own risk.

Good Morning. Today I am hosting the first Hangout on Google + for Health Professionals, Physicians, and Health Information Professionals. Date: August 31, 2011: Time: 1PM PDT, 4PM EDT. Place: Google Hangouts. Search for Gary Levin and Click on the Green “Join” tab. Invites will be sent out at 12:30 PM today. The Hangout room will open at 12:50, sign in early since there are only 9 spots in addition to mine. The Agenda will be organizational. the Hangout and topics to be discussed and a forward looking schedule for the next six months.

Some possible topics: EMR Incentives, EMR adoption, ROIs are there any ? Experiences of Early Adopters. Thoughts on Diagnostic and Treatment Algorithms. Use of tablet PCs.

Or look for the Join This Hangouttab on my profile page on the right by searching for Gary Levin in the search box on the main stream page of Google +. Sign in early, check your mic and video.

Tuesday, August 30, 2011

I admit it. My interest in the blog has waned the past month, since I discovered G+. This is serious ! I have an addiction to G+, especially ‘Hangouts”. I am finding many of my fellow Bloggers over there asking me to ‘Join the Hangout”. I spent the past week building my circles. Constantly amazed at people who have 100,000 followers…I must be missing something. However the sillier the message, the more followers you will have. I will be back again in about a month or so. Do watch for my Hangouts, though.

Monday, August 22, 2011

SAN FRANCISCO — Until recently, medical files belonging to nearly 300,000 Californians sat unsecured on the Internet for the entire world to see.

There were insurance forms, Social Security numbers and doctors' notes. Among the files were summaries that spelled out, in painstaking detail, a trucker's crushed fingers, a maintenance worker's broken ribs and one man's bout with sexual dysfunction.

At a time of mounting computer hacking threats, the incident offers an alarming glimpse at privacy risks as the nation moves steadily into an era in which every American's sensitive medical information will be digitized.

Electronic records can lower costs, cut bureaucracy and ultimately save lives. The government is offering bonuses to early adopters and threatening penalties and cuts in payments to medical providers who refuse to change.

But there are not-so-hidden costs with modernization.

"When things go wrong, they can really go wrong," says Beth Givens, director of the nonprofit Privacy Rights Clearinghouse, which tracks data breaches. "Even the most well-designed systems are not safe. ... This case is a good example of how the human element is the weakest link."

Southern California Medical-Legal Consultants, which represents doctors and hospitals seeking payment from patients receiving workers' compensation, put the records on a website that it believed only employees could use, owner Joel Hecht says.

The personal data was discovered by Aaron Titus, a researcher with Identity Finder who then alerted Hecht's firm and The Associated Press. He found it through Internet searches, a common tactic for finding private information posted on unsecured sites.

The data were "available to anyone in the world with half a brain and access to Google," Titus says.

Titus says Hecht's company failed to use two basic techniques that could have protected the data – requiring a password and instructing search engines not to index the pages. He called the breach "likely a case of felony stupidity."

The personal data was discovered by Aaron Titus, a researcher with Identity Finder who then alerted Hecht's firm and The Associated Press. He found it through Internet searches, a common tactic for finding private information posted on unsecured sites.

The data were "available to anyone in the world with half a brain and access to Google," Titus says.

In the wrong hands, health records can be used for blackmail and public humiliation. The information can also be used by insurance companies to inflate rates, or by employers to deny job applicants.

Usually when personal data are exposed, it's the result of a network break-in by a hacker or a theft of computer equipment. Sometimes, it can be a simple case of someone mishandling the information.

Leaks are more likely the more data are passed around within the health industry's increasingly interconnected networks.

Dozens of companies can be authorized to handle a single person's medical records. The further away from the health care provider the records get, the flimsier the enforcement mechanisms for ensuring the data are protected.

That's exactly what happened at Hecht's company. Hecht declined to go into further detail about how the information ended up online. He says many of the Social Security numbers and basic details about people's injuries were part of a database his firm compiled from information regularly sent by the state.

As instances of data mishandling become more commonplace, government officials may seek greater control over security policies of companies with access to health care records that aren't currently regulated.

Can electronic medical information be insulated from hackers? When there is a will, there is a way…Perhaps key identifiers should not include social security numbers. There are other identifiers available from computer algorithms which factor in date of birth, previous addresses, which are already in use by credit card agencies.

While there are strict HIPAA protocols, it falls upon companies and entities far removed from the point of care delivery. Caveat emptor to the patients!

Saturday, August 20, 2011

Barbara Duck in her blog “The Medical Quack” interviews Dr. Hamlaka, the outgoing CIO of the Harvard Medical School. He along with Sean Nolan have said, and why It's time to take a break with a Health IT-Interview with Dr. Halamka and why he's stepping down as Harvard Medical CIO-there's too much on the plate tellilng ONC to ‘take a vacation’

PLEASE, TAKE A BREAK!JUST STOP TALKING FOR AWHILE AND LET US IMPLEMENT STUFF.

My thought on this is “sure”. These federal employees are PAID to generate paperwork. Your tax dollars and mine are caught up in this process. Their ‘quarterly assessments” depend upon the volume of bureaucratic edits, they produce. If they stop their job is in jeopardy. It is a self-propagating process at work in all areas of government unless Congress stops their funding.

“ I’ve spoken at some length about my enthusiasm for the current leadership at HHS and ONC. President Obama has both directly and indirectly engaged some really gifted individuals to help us address healthcare challenges through the use of information technology --- which is awesome. In particular, folks like Aneesh Chopra, Todd Park and Farzad Mostashari have brought the Internet to healthcare (or perhaps more accurately, healthcare to the Internet), and have convened some super-effective public/private groups to collaborate on specific issues with real success. I’ve had the good fortune to participate in a few of these, and it’s been some of the most rewarding work of my career.

Why stop now? I think the answer is increasingly clear. Between Meaningful Use Stage 1, the Direct Project and theHealth Data Initiative, government has kicked industry out of a funk it’s been in for the previous decade, and we’re seeing a ton of really exciting and positive innovation. But nobody, and certainly not ONC, knows at a detailed level how to turn that innovation into ubiquitous market reality. What we need now is a period of implementation, competition and iteration to figure out how to deliver on the promise.

What we need now is time for the system to work, partnerships to form, software to be upgraded in production systems, ideas to be tested, consumers to choose what to buy and what not to buy.

I’m not asking for the pace of innovation to slow down --- capitalism takes care of that just fine (even in healthcare, when the conditions are right). I’m asking for the government to slow down … recognize that ONC has found an incredible recipe to guide progress, but that it will only keep working if used strategically.”

Friday, August 19, 2011

Sometimes I believe I should change the name of my blog to Health Rocket Express. Advances are proceeding at such a rapid rate that my Health Train cannot keep up with all the issues, social, technical, patient care, research, patient advocacy and more. Far cry from my days as a very focused ophthalmologist. I find the new age just as exciting as it was when I took out my first cataract or corneal transplant surgery.

All of these technologies come at us simultaneously and compete for our attention. What to adopt? Will it be obsolete next year, and/or replaced by another advance? Rapid advances in imaging techniques with MRI, PET Scans, Minimally invasive surgery in cardiology, abdominal surgery, neurosurgery, orthopedic surgery.

Witness the transition and battle between Google Plus and Facebook. A single social presence is not tenable at this point. Sermo has become a central focus for physician discussions. Some of it is purely social, but there is a great deal of clinical information exchange.

You may say, who needs it? My answer is “Build it, and They will come” much like “Field of Dreams”, we are at the point where many of our dreams are here, now.

Social networking increases our power to communicate, not just in health issues, but politically as well. We can be heard..en masse. Most politicians now have a social media presence with a dedicated social media staff. It can’t get much more democratic that Twitter, Google Plus or Facebook. Aside from patient care and HIPAA restrictions there is so much to do with these platforms it is as revolutionary as the telephone or even the PC revolution which made it all possible. All of the aforementioned platforms have mobile applications on Android, iOS, and Windows 7 phones.

All of this innovation comes simultaneously with proposed massive changes in health care delivery. This has created a stimulus for communications between providers, organizations, congress, consultants, and pundits. We can certainly have our interests and opinions fairly presented, as organized medicine and even more important as individuals not aligned with political action committees and/or the influence and corrupting power of campaign donations.

Sunday, August 14, 2011

At one time there were only about 8 primary crayola crayons to chose from. Much like health insurance. However today we are faced with many more, not just in crayola colors, but the byzantine of flavors of health insurance coverage, with most having some blank spots somewhere or other.

The Image above is a ‘Radial’ design, however the same data can be presented in ‘Cartesian” format, below:

This brought to mind the charts and tables that appear in many medical journals and articles. Nothing can be more boring that trying to decipher what a chart or table lists.

The visual system does not organize tables into constructs for interpretation. Colors stimulate many more neurons, not just in the visual pathway but through interconnections that are sensory (ie, pain pathways which elicit photophobia in migraine attacks) Some of these connections may also go to higher cortical centers in the parietal lobes, prefrontal cortex, limbic system and other centers connected with emotional reaction. Consider the fact that blue elicits sadness, red-anger, and why do flashing strobe lights precipitate seizures in some people? All food for thought. A bit off topic for health train express,

Have you been to the emergency room lately? Everyone tries to avoid ERs. For one thing they are meant for emergencies, and despite that fact there are many who use the ER in the evening on the weekends and holidays when their doctor is not available. This is especially true if you see a physician in a small group or a solo practitioner. Many sign out to the ER, and because ERs must examine all comers (by law) these patients add to the constant stream. Some arrive at the ER from an accident, some have no physician at all. Wait times are variable The frequency of true emergencies is very small. Triage is critical, and in some cases there is an urgent care center nearby that a patient can be referred to.. In our particular hospital there is a common reception area and a nurse practitioner or physician assistant screens a patient and refers them left to urgent care or right to the emergency department. Any chest pains are immediately shunted to the vital signs room to be hooked up to monitors, have blood drawn and have a detailed history taken.

The topic of my blog is not about triage and treatment in the emergency room but how ED visits are billed in general. This was brought to mind when I received a Medicare Summary Notice from 18 months prior to receiving the notice. It speaks loudly about problems which simmer and simmer but never seem to be addressed.

The notice :

This is a typical Medicare Summary Notice which Beneficiaries receive in a month where their CMS has been billed:

1. Please notice the date of the notice: upper right corner: July 27, 2011. It arrived in my snail mail box on August 12, 2011.

2. Notice the Date of Service: 02/03/2010, the ED location was in a small town in Georgia.

3. Notice the billing address is in Texas.

4, The providers were from an ED group (not the radiologist however).This is not uncommon because many EDs are staffed by companies that provide ED doctors for an entire region or part of one.

5.The total amounts billed to Medicare were $ 755.00 and $ 180.00, while the Medicare approved amounts were: $ 114.14 and $ 42.10, and the CMS payments were: $ 91.31 and $ 33.68. The remaining balance that I ‘might be billed’ was $ 22.83 and $ 8.42 .

Had I not had insurance, or Medicare I would have been billed the totals amounts of $ 755.00 + $ 180.00. The hospital might have given me a cash discount if I asked, however they would not volunteer that information.

The questions arise:

1. Why did it take 19 months for me to receive a summary notice? You will notice the claim was processed between July 12-15 2011. Was the bill sent in 16 mos late? CMS usually pays an electronic claim within 14-21 days. Why did it take the providers 16 mos to submit their charges to CMS. Imagine if you will what their accounts receivable must look like.

2. Should I be euphoric that the bill was for $ 935.00 and I only would get billed: $ 31.25

3. No one can really construct a logical reason why the amount billed, the amount allowed and the amount paid are so disparate. It must be the law combined with an attempt to show immense billings as a measure of importance for that hospital in a chain.

Not many people plan to go to the ED, but there are some who do. Drug dependence is one area where patients make elective visits to the ED. There are not that many choices in picking an ED, so price comparisons don’t play a big role in selecting an emergency department.

I’ve been a physician for 40 years, and this was going on when I started practicing, so it is nothing new…

During the past few years, some hospitals have held a "speed-dating" event, in which young adults briefly interviewed physicians for five minutes before moving on to meet other doctors. The reasons are thus: "trying to attract young adults and educating them on the importance of seeing an established doctor, and the importance of preventative care."

And thanks to health system reform, there will be a whole lot more of 20-somethings to attract.

. Generally, people age 20 to 40 are healthy."

Even if young adults are looking for medical care, it's not automatic that a physician's office will be the first place they go. According to a May 2011 report by PwC's Health Research Institute, 42% of consumers age 18 to 24 prefer to use an independent company, a website or one owned by a pharmacy, rather than a traditional doctor's office, compared with only 15% of consumers 55 and older who would go somewhere other than a physician practice.

Reaching a younger population

By using certain techniques to reach out to young adults, experts said, practices will have a better chance at capturing the population of new, young insureds that is coming. One way to reach out, they said, is to meet young adults where they live -- online.

At least two-thirds of young adults "are likely to use health care conveniences such as online scheduling and email communication with health care professionals," according to the Harris Interactive/AAFP study.

"I am not sure if the increase in the patient base would warrant a complete retooling of the physician's communication," Tsang said. "That said, it may not be a bad idea for the doctor to be on Facebook, have a follow-me account on Twitter, and put out some videos that address the most popular concerns of the younger folks."

Click Image to Link

Do you have a facebook page, or twitter account? They can be used for social communication by the office without being personally attached to you for non medical issues and those not protected by HIPAA privacy and confidentiality rules.

How about a Google ‘Hangout” for a group session on Diabetes, or Hypertension.? Hire a part time high schooled to advise you and setup the technical side of this media opportunity.

Unless one has their head inside an endoscope it is obvious change has occurred.in the healthcare space.

What was once deemed a trivial pursuit is now mainstream in MDs daily lives.Be it an EMR, HIE, Smartphone, Tablet PC, Bluetooth in the car, or even when rounding at the hospital or in the office, all of this technology revolves around communication.

Who reads a newspaper anymore? I admit to missing that newsprint smell, but I don’t miss my ink allergy. I miss my AM sneezing fit and my PC just does not have an aroma add-on.

Take a look at your waiting room!

Is that an iPad the doctor is using? No, sadly it is an old clipboard, yellow pad and a No 2 pencil. I hope his waiting room has wi-fi. Also I hope the office has online appointment making, and an online portal for lab and/or x-ray results. If this MD had an IT advisor he would already know about CMS incentive programs, health information exchanges, EMR, HITECH, ARRA, and meaningful use reporting.

Online Portals are available and can even be linked to the practice EMR.

Online portals offer a secure HIPAA compliant solution to reduce telephone calls. Many labs provide them free of charge to patients and physician offices as well.

Few 20 somethings can even go potty without their smartphone, facebook, twitter, and now G+. They hangout on G+ with nine friends at a time with streaming video audio and text chat.

You might want to put up a placque in your reception room stating ‘wifi hotspot and ‘android certified’ or iOS certified. In addition to that a reception room kiosk for registration and time checked in.

If your patients have a long wait they can go to Starbuck’s (only if they are not having a fasting blood test.) then have the office SMS them, or better yet, a tweet when it is their turn.

And have you found Linkedin? Many physicians now have a professional grade site which allows resumes, work experience and education as well as training. There is a place for special accomplishments, hobbies, and a feature that allow you to network with hundreds, thousands and more people.

Sunday, August 7, 2011

Gwen Olsen, a former pharmaceutical representative elaborates on some shocking news !

Buried in what we read and hear about health reform and the root causes of health care inflation is the cost of pharmaceuticals. We are told and shown reams of data how physician ordering, hospital inflation, aberrant and inequitable coding creates a motivation for unnecessary procedures, overuse of emergency departments, created our present morass.

Not much is told about the role of big pharma. Nor the tremendous disparity of drug costs at the counter between cash paying customers, insured customers, or the cost for patients on government programs, like Medicare, and Medi-cal.

Volume purchasers such as CMS, and other federal programs, ie, DOD, VA as well as large institutional systems such as Kaiser Permanente, Mayo Clinic, Cleveland Clinic receive a disproportionate share of discounts

Compassionate care programs offer medications to tens of thousands of patients who are uninsured or economically disadvantaged. Most of the processing times run in the one month time period to process a compassionate drug program order. These programs are necessary, and they must be amortized. It’s not free, and we all pay for it since the pharmaceutical company recoups that loss in some way.

The profits of Pharma increase each year and Pharma;s profits are five to six times that of the other Fortune 500 companies.

In reality, most physicians write a prescription and don’t give much thought to it’s costs unless they belong to a system that has a formulary and trained professionals who select the drugs for the formulary.

Formal training in nutritional alternatives, exercise, and other methods is almost non-existent in most of the top medical schools, as described by Peter McCarthy, N.D. and Rahdia Gleis, M.Ed.,C.C.N. in this telling video:

Some of the material is highly biased, the speakers do not discuss the role of post-graduate education which is at times as long as formal medical school. They also do not explain the lack of evidence based medicine for many herbal treatments, nor take into account that most herbal users also are following strict nutritional programs.

While I know that this presentation is a bit over the line, however it brings some attention to the lack of knowledge and bias by allopathic physicians.

Disclaimer

The opinions in this blog or other forms of social media are solely that of Gary M. Levin M.D. Dr. Levin has no financial interests in any medical devices which are discussed or which appear in the blog. Commentary taken from other sources are either quoted or referenced with attribution. Dr Levin does not endorse, nor give financial support to any political organizations.